A Needs Assessment of Ithaca College Students Awareness ...

A Needs Assessment of Ithaca College Students
Awareness, Knowledge, Behaviors and
Attitudes Toward Smoking Hookah
Researched and Presented by:
Alexandra Ferretti
Lindsay Jones
James Onisk
Gina Rosato
Prepared for:
Srijana Bajracharya, Ph. D., CHES
Associate Professor
Development and Evaluations of Health Programs Class
Department of Health Promotion and Physical Education

Table of Contents
Acknowledgements……………………………………………………………….3
Abstract…………………………………………………………………………...4
Introduction………………………………………………………………………5
Literature Review…………………………………………………………………9
Methods…………………………………………………………………………..14
Project Logistics……………………………………………………………..........18
Results…………………………………………………………………………….21
Discussion…………………………………………………………………………26
Recommendations…………………………………………………………………29
For the Hammond Health Center
For Future Student Participating in the Service Learning Project
References……………………………………………………………………........33
Appendix A
Application
Survey
Appendix B
Appendix C
As Told by the Students- Qualitative question
Informational Sheet
2

Acknowledgments
We would like to thank the following people for helping in making this project
successfully. We want to give a special thanks to Dr. Srijana Bajracharya for all her guidance
and support throughout the development of this project throughout the semester. Thank you to
Erica K. Weiss for giving us information with regards to the rising issue of tobacco and Hookah
use on campus. Also we would like to give a big thanks to Tom Swenson, Shewanee Howard
and Joanie Groome for allowing us to conduct our surveys in their class rooms. Lastly we would
like to thanks all our classmates for helping us in the development of our survey, the conduction
of it as well as their input and suggestions throughout the service learning project. If not for all
these people, the success of this service learning project would not have been possible.
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Abstract
According to the American Lung Association news report, hookah bars are emerging
across the United States especially among the 18-24 year old crowd. It is becoming the “new
tobacco trend of the 21 st century,” (American Lung Association, 2007.) However, the problem is
not just the increasing trend but also the lack of knowledge regarding the dangers of Hookah use.
The fact of the matter is that a session of smoking Hookah usually lasts approximately forty-five
minutes versus the usually five to ten minutes it takes for an individual to smoke a cigarette. In
those forty-five minutes a person inhales the equivalency of a whole pack of cigarettes (The
Bacchus Network, 2007.) The facts are that in Hookah smoke there are higher levels of arsenic,
lead and nickel, thirty-six times more tar and fifteen times more carbon monoxide than cigarette
smoke (Bacchus Network, 2007.) The population that is most affected by this trend is the college
population. Much of the population is misinformed about the health risks that are associated with
the use (Bingler, 2009.) College students state that smoking hookah is a nice way to relax after a
stressful day and because people think that it is less dangerous than smoking cigarettes, it is more
appealing (Bingler, 2009.) It is for this reason that the Hammond Health Center wanted to
conduct a needs assessment for the prevalence of Hookah use at Ithaca College as well as the
knowledge, awareness and attitudes of the students. The results showed that many Ithaca College
students lack the knowledge regarding the nicotine levels in Hookah and believe it be a safer
choice than cigarettes. Based on those results, the Hammond Health Center will structure
informational pamphlets and seminars to create a campaign to educate students on the dangers of
Hookah use.
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Introduction
Tobacco takes someone‟s life every six seconds. It also kills a third to a half of the people
who use it about 15 years prematurely. Tobacco use causes 1 in 10 deaths among adults
worldwide and more than 5 million people a year. If nothing is done about this problem by the
year 2030 tobaccos annual death toll will rise to more than eight million. Many have come to
believe that using other kinds of tobacco or smoking it in different ways will be less hazardless,
which is not the case. A popular form of smoking tobacco by college students is through a water
pipe or “hookah.” (The global tobacco crisis)
Experts have estimated that 100 million people worldwide smoke tobacco from water
pipes, otherwise known as “Hookah” on a daily basis. The Global Youth Tobacco Survey
collected data on more than 90,000 adolescents ages 13 to 15 living in countries within the
Eastern Mediterranean region. This Survey found that 3% of girls and 7% of boys smoked
cigarettes, while 10% of girls and 16% of boys used tobacco by other means, which was mainly
through the water pipe. Studies in the United States have indicated that there are medium to high
levels of college students who have experienced smoking hookah. An Internet survey at Johns
Hopkins University found that 15% of freshmen had tried water pipe smoking at least once in the
previous month, and a survey of undergraduates at Virginia Commonwealth University found
that 48% of those who responded had tried water pipe smoking at least once; 20% were active
users at the time of the survey. Water pipe smoking is widely perceived to be less harmful and
addictive than smoking cigarettes or other forms of tobacco. Yet many public health officials
believe this form of smoking may be just as addictive as and perhaps even more harmful than
cigarette smoking because of the way people smoke while using a water pipe. (The Hazards of
Hookah)
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Tobacco use is costing the world hundreds of billions of dollars every year and tobacco-
related deaths result in lost economic opportunities; In the United States, these losses are
estimated at $92 billion a year. The economic cost of tobacco-related deaths imposes a particular
burden on the developing world, where four out of five tobacco deaths will occur by 2030.
Tobacco‟s impact on global health-care costs known to be high; In the United States, annual
tobacco-related health-care costs are $81 billion, in Germany nearly $7 billion and in Australia
$1 billion. (The Global Tobacco Crisis)
During any day of the week, college students all over the country can be found smoking
hookahs as a way to socialize just as smoking cigarettes or cigars are; Ithaca College is no
exception. Students are frequently spotted sitting outside on the lawns outside the dorms in small
groups. This is just as large of a problem as smoking cigarettes because many students don‟t
know the health risks of smoking a hookah, as they assume that it is a healthier choice than
smoking cigarettes and smoking hookah is less of a concern (University of Pittsburgh, 2009).
The health risks of hookah are very serious, and a University of Pittsburgh study revealed that
one hookah smoking session “exposes the user to 40 times the tar of a single cigarette”
(University of Pittsburgh, 2009). The WHO has also stated that hookah smoking leads to
inhaling smoke over a longer time period than cigarettes, and exposes the smoker up to 100
times more smoke than a single cigarette being smoked (MSNBC, 2007).
In terms of who smokes hookah, almost 9000 students were surveyed and athletes were
less likely than non-athletes to smoke cigarettes and hookahs; on the other hand, club sports
athletes were more likely to smoke from a hookah than non-athletes (University of Pittsburgh,
2009). As the Ithaca College campus is comprised of students from all different backgrounds, a
majority of the school attendants are not varsity athletes, which means they are more likely to
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smoke hookah. Hookah bars are also very popular in the college atmosphere, and although there
are none in the commons near Ithaca College, students are exposed to them when they travel
anywhere else. Our mission for this survey is to find out the population size of the students who
smoke hookah, so they can be educated about the health risks involving the smoking process.
Based upon the evidence above, it is clear that Tobacco in the form of chewing and smoking
Hookah is just has deadly if not more so than regular tobacco from cigarette use. It has also
become apparent that people, including the students at Ithaca College may not be aware of the
dangers that these daily habits are the consequence with. Education is key in order to help solve
the tobacco chew and hookah use that is sweeping college campuses everywhere. In order to
lessen the problem, we are proposing the health programs, “Don‟t Get Hooked on Hookah” be
placed inaction. These programs will education and offer intervention to the students on the
Ithaca college campus about the health hazards of tobacco chew and hookah use. Through this
education program, it is the hope that the students will think twice before they engage in such
activities and take the proper steps to quit if already addicted.
The first step prior to implementing the “Don‟t Get Hooked on Hookah” program is to
find out how apparent the health problem in on our campus and which populations within the
college that it is most prevalent. A survey will be created and conducted throughout the campus.
The survey will find out who smokes/chews, how much they smoke/chew, what they
smoke/chew, in what environment do they do it and what are their reasons. The survey will also
expand to find out the knowledge of our population on the effects of these habits toward their
health. After data is collected, it will be organized, analyzed and review.
The next step implementing this program will be to create informational packets exposing
the truth of the effects and diminishing any possible misconceptions that might have made with
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egards of tobacco on the body, facts about the tobacco in hookah and what use can lead to in the
future. There will also be a step program and support lines for someone who is hoping to quit
and needs aid in the process. Possibly an informational meeting can be held for any student
interested in learning more about the health related issues with hookah use. Once the program
has been implemented, an evaluation will need to be done via survey or interview to see the
success rate of the program and any possible changes that may need to make in order to help
students understand and want to change these unhealthy habits.
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Literature Review
The Hookah, also known as shisha, narghile or hubbly bubbly (Gatrad et al, 2007)
originated in India over four hundred years ago (Primack et. al, 2006.) A hookah is water pipe
device used for smoking tobacco and uses indirect heat and filtration to filter the tobacco into a
form that is easily inhaled. The hookah uses foil and charcoal in order to heat and then cool the
smoke before inhalation. This is achieved by first placing the tobacco into the bowl that, through
pipe is connected to the water filled base. One would then cover the bowl with any kind of
perforated material (one common resource is kitchen foil) and the place the charcoal on top of
that. When it is lit the smoke of the burning charcoal gets pulled through the tobacco and into the
water filled based. It then cools and is released through the tubes where it is inhaled (Gatrad, et
al, 2007.) The first hookahs, created in the provinces of India, were simply in design, made
coconut shells and other natural resources. Their original purpose was for the use of smoking
opium and hashish, (Hookahcompany.com, 2009) both of which were used in ceremonial and
celebratory events. The design and concept of a hookah soon traveled around the world. It was
popularized in Turkey approximately five hundred years ago. It was in Turkey that the hookah
bars arose from and the hookah design was greatly changed and made more complex, crafting
into the hookah style that we see today. After dominating in Turkey, the hookah swept into the
Arab areas, Pakistan, parts of Africa, Europe and the United States (Hookahcompany.com,
2009.) The number of Hookah bars, head shops and users has increased as hookah becomes the
new trend in smoking tobacco. This drastic increase have many public health officials worried
about the health consequences of extended use; they have characterized this recent trend as a
global epidemic.
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Although hookah use had subsided for a couple of decades, it has recently been revived
and now hookahs and hookah use is seen everywhere around the world. More and more
individuals, aged twelve and older are acquiring this new habit of hookah smoking. In Arab
areas, hookah use has become a favorite past time and hookahs are seen in restaurants, coffee
houses as well as bars. In 2008, The Global Youth Tobacco Survey was distributed throughout
Iraq schools. Based on that survey, of the students aged thirteen to fifteen, 12.9% had smoked
hookah before and 6.3% were currently smoking hookah (CDC 2008). Also based on that
survey as well as other studies conducted it was also relieved that boys were 97% more likely to
smoke hookah, based on the statistic that boys are twice as likely to use hookah as opposed to
smoking cigarettes. Most revealed that they were exposed to smoking in public places first, as
well as by their parents. 13.1% of students parents themselves smoked hookah (CDC, 2008.) A
survey conducted by the Center of Disease Control, World Health Organization and the
Canadian Public Health Association documented the use of tobacco use among students. The
Global Youth Tobacco Survey that was conducted at 395 sites among 132 different countries.
The results concluded that nearly two out of every ten students had engaged in tobacco use. It
found the use of hookahs to be most popular in the Eastern Mediterranean, South-East Asia and
the Americas (CDC, 2006.) However, this trend is making its way across the ocean to the United
States and hitting the younger populations.
The target group for our study is the collegiate population, in which we frequently see
students of all ages smoking hookah throughout the campus of Ithaca College. On the national
level, the use of hookah to smoke tobacco has increased over the last decade. According to
hookah-bars.com, there were four-hundred and seventy hookah bars throughout the United States
listed on the site in October 2008. Every month there are five more hookah bars opened. Based
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on reviewing the site, hookah bars are most apparent in California with Arizona and Tennessee
and New Jersey close behind. The increasing number of hookah bars leads to an ever increasing
number of opportunities for collegiate students to experience with smoking hookah. As for the
prominence of college students actually smoking tobacco from a water pipe or hookah, a recent
University of Pittsburgh study revealed that “40 percent of college students at a large university
have smoked tobacco from a water pipe, or hookah” (UPMC, 2008). The sample size used in this
study consisted of six-hundred and forty seven undergrads and graduate students (UPMC, 2008).
In addition to these findings, the study also found that only a .4% difference separated the
number of students who had smoked hookah from a water pipe (40%) and the percentage of
students who have ever smoked cigarettes (39.6%) (UPMC, 2008). Another University of
Pittsburgh study revealed that 15.1% of high school seniors at an Arizona high school have
experienced smoking a hookah (UPMC, 2009).
All of this information is important in revealing the prominence of hookah use among
college aged students. The 15.1% in high school seniors that have experienced smoking hookah
will soon be college freshmen, and can spread the use of smoking hookah to other freshmen at
their future colleges. Also, the fact that 40% of college graduate students and undergraduate
students across the country are reported to have smoked hookah gives us great data to base our
future findings of the prevalence of hookah use among Ithaca College students.
Hookah use in New York State is not widely known. Studies have shown from a national
and global perspective that it is common among college student age. The bigger cities such as
New York City have hookah bars or cafes. Even though New York State has a smoking ban in
effect now, laws aren‟t regulating the hookah use by consumers of college age. The American
Lung Association displayed data that confirmed bars and cafes to be the most common place
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where hookahs are being used most commonly nearby campuses. A reason why hookahs use
such as in tobacco and cigar bars are not being regulated is that there is a percentage of the
state‟s revenue to be supporting the business aspect of it. Around 10% has to be made from the
state just in tobacco sales, (American Lung Association, 2009.) Even with the smoking laws in
place, some of the New York City bars and restaurants haven‟t lost any business. In fact they
have increased their sales because more people are going there, and also more employees are
being hired. About 160,000 people were hired in either bars or restaurants since the “no smoking
laws” were established back in 2003, (Elliott, 2003.) More and more people want to go to places
like bars and restaurants now since they don‟t have to breathe in the second hand smoke. In the
end hookah use is a well kept secret. It needs to be researched more in the realm that it is
becoming popular among the older teenage years and widely common on college campuses. In
New York State the smoking ban doesn‟t involve hookahs as in the equipment but just the
tobacco that is being used to smoke is illegal.
Nearly 15,000 adults smoke tobacco in Tompkins County and the county along spends
$36 million a year in medical costs. Smoking is the basis of about 2.7 million in medical money
paid by this county. Weather this kind of tobacco use is related or contributes to the use of
Hookah among college students is unknown. Recent articles and discussions have expressed a
general prevalence of Hookah use on college campuses in Tompkins County.
Discussed at the local level, Hookah use is widely used and discussed through both Ithaca
and Cornell campuses. An accent story titled “Hookah Palooza” was published in the Ithacan in
April 2005. The article describes a social gathering of the recent Hookah Club a student had
founded called “Nargile and Nosh.” The club is organized, with a music coordinator, and social
coordinator and even had a weekly meeting time in the founder‟s Garden Apartment on Ithaca
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College campus. “Members gather to relax and smoke from the Hookahs, the club was started at
the beginning of the spring semester as a social gathering, a way to unwind after a long week.”
Members described their feelings about smoking hookah, “the best thing for me about smoking
the hookah is how relaxing it is, it‟s very easy to talk to someone while you‟re smoking the
hookah because it takes away the awkward silences.” The article then goes on to describe the
dangers and health problems related to the drug. Hookah has seemed to evolve around the
campus and has grown in popularity as more students experiment with it. The founder of the club
describes that he got interested in hookah by realizing what it was when he toured other college
campuses; “Every single college I went to had Hookahs, hookahs were everywhere, I realized
when I came here that I had not seen anyone with a hookah,” (Munzer, 2005.) He also
remembers how he was the only person in his dorm with a hookah, but by the end of the year up
to eight other students had joined in with the trend. Students seem to view hookah as more of a
way to socialize and seem to ignore the health effects and dangers of hookah use.
A Facebook discussion board about hookah also expressed the wide use of the tobacco
among college students; the discussion also expressed needs and wants of a hookah bar because
they were not allowed to smoke in the dorms. Students discussed where to buy hookah pipes and
where they smoke. One student‟s response to the absence of hookah bars in Ithaca, “As for
Hookah, this is a hippie town and there are plenty of shops to pick up tobacco or coals, but sadly
there is not a single hookah bar in city limits. In passing a friend of mine said that every year,
one of the MBA‟s at Cornell‟s Johnson School of Business submits a business plan to establish a
hookah bar in Ithaca. But so far, for reasons no one doubt tied to NY State anti-smoking laws,
and Ithaca City Council‟s tug of war between the „healthy‟ and „Boho‟ sides of “ hippiedom”, an
Ithaca hookah bar is just a stack of business plans.”
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Even though it is obvious that hookah use is widely used among the college population
within Tompkins County the numbers and statistics are still missing. Therefore the purpose of
our service learning project is to find out these statistics through the conduction of a survey
which will evaluate the knowledge, awareness, behavior and attitudes toward hookah use. It is
hoped that through these service learning project, the Hammond Health Center will be able to
develop informational programs and pamphlets regarding hookah and the consequences of using
it.
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Sample
Method
For the purpose of this study, we randomly selected classes from Ithaca College that are
qualified as general education/ LA requirement
courses to make sure that we get the most
heterogeneous population. The students have an
age range from 17-25, and consist of freshmen,
sophomore, juniors, seniors and grad students.
Students surveyed were of different ethnicity,
backgrounds, and majors to better our data and
provide us with more accurate information.
The classes in which the students were surveyed
were Anatomy and Physiology, Human Nutrition,
Personal Health as well as students selected
randomly throughout campus. These classes each
had approximately 35 students in each and a large
variety of year levels (Table 1.)
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Variable Percent
Gender
Female 58
Male 40.2
Transgendered 1.5
College Standing
Freshmen 46.4
Sophomore 17.5
Junior 25.8
Senior 9.8
Graduate 0.5
Age
17 0.5
18 37.9
19 19.9
20 20.4
21 10
22 2.4
Ethnicity
White/Non-Hispanic 83.4
African American/Black 4.7
Latino/Hispanic 3.6
Asian/Pacific Islander 5.7
Other 2.6
Major
HSHP 75.9
Business 3.7
H&S 7.9
Music 2.1
Communication 4.7
No Answer 5.8
(Table 1)

Instrumentation
In order to successfully analyze the relationship between hookah use/knowledge and this
population, a survey was developed. This survey was cross sectional and it consisted of 39
structured questions regarding the beliefs, attitudes, knowledge, awareness and behaviors of the
students of Ithaca College. In order to obtain the data, the survey had structured multiple choice
questions as well as likert scale questions to obtain information about attitude and awareness.
The majority of the data was quantitative, asking only one qualitative question at the end to aid
in gaining a better understand in student‟s beliefs on the safety of Hookah use.
Based on the Health Belief Model, there are three main factors that predict the likelihood
of preventing a behavior. Those factors are first, motivation; second, perceived threats which
later act as a driven force for that motivation and third, the overall belief that the benefits will out
weight the costs. The format of our survey will help us analyze these three aspects and help the
Hammond health Center create a successful campaign in educating students on Hookah use. As
any health program there are many barriers that can arise which will prevent success. One such
barrier that can arise is a lack of education. Without knowledge, people may be unaware that
they are at risk. Other barriers can include time to make changes, information on how to make
those changes, resources and/or access.
After analyzing the data, we were able to detect the reliability of our survey. It was found
to be .45 reliable. This number is fairly low. However, when we did the reliability of certain
questions such as the group of perception questions, the reliability increased to .65. The reason
for the discrepancy is simply that in our survey, there was one question which told you to either
continue on with the survey or to skip to the end and fill out the demographics based on the
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subjects answer. Because of this technique used there were many questions that were left blank
leading to the decline in our reliability.
Research Methods
This study used a cross-sectional research design. A self report survey was filled out by
the subjects using paper and pencil that supplies quantitative data about hookah use among
college-aged students. The students were chosen by visiting a variety of classrooms concerning
different disciplines of study, and taking the survey during class time. To protect the rights of our
participants, they were informed that none of their information will be linked to their names or
information, and they also don‟t put names on the survey itself. The survey consists of multiple
choice, ranking, and demographic questions which the subjects have time to fill out. After the
surveys are handed back in, they will be analyzed by our group to find the prevalence of hookah
use on campus and the extent of students‟ knowledge in order to assess hookah use and give
feedback to the Ithaca College Health Center about whether or not hookah information should be
delivered to the students
Research Questions:
a. What proportions of Ithaca College students were aware of Hookah?
b. What were the general perceptions of Ithaca College students regarding Hookah?
c. What proportion of Ithaca College students are current users of Hookah?
d. What was the expense of hookah use for Ithaca College Students?
e. What health risks do Ithaca College students associate with using Hookah?
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Data Collection
Data were collected using a paper and pencil survey instrument dispersed among Ithaca
College students in a classroom setting. Before administration, the survey was put through two
rounds of pilot testing in which we gained feed back in order to make sure that the questions
were clear and understandable and that the participants were interpreting the questions the same
way. Through these tests we were able to create a survey that had high reliability. Once the
piloted test was complete the survey was distributed to students. Prior to the distributing the
survey to the students, we informed all participants what the purpose of the survey was, that they
must be eighteen or older to complete, that participation was voluntary and they could stop
answering questions at any time and also that the answers collected on the survey would remain
anonymous. For further questions we provided contacts where students could get more
information regarding the project and survey.
The first step we did in creating our questionnaire is, after researching our topic we all sat
down and started coming up with questions that we thought would be important to include in the
questionnaire; we chose to focus on questions that would reflect individuals attitudes, beliefs,
knowledge towards Hookah. We also included a demographics section at the end of the
questionnaire. After creating a draft of questions we got feedback from our professor and
classmates about the types of questions we included. This helped us develop a more concise
survey to perform a pilot test on. The pilot test was conducted within our classroom as well as
one outside classroom. The purpose of the pilot test was to identify and correct and problems
prior to implementation of our survey to the Ithaca College students. The pilot test allowed us to
adjust our survey in order for it to be ready for a real distribution.
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Along with performing a pilot test our group members had to go find a sample population
to give our survey to. We are going to be using the method of convenience sampling in order to
perform the survey on as many students with the time allotted. Group members will be
distributing the survey to various classes on campus of 100 students or more in order to have an
appropriate sample size of students to see trends in our data when we start analyzing it.
Data Analysis
For our survey of Hookah Use among Ithaca College Students, we used a computer
program called SPSS to analyze the data collected from the surveys. SPSS is a computer
software program that allows us to input our data from the surveys and then it is statistically
analyzed. We analyzed each question for a valid percent variable and used that as a highlight in
our charts and graphs. Cronbach‟s Alpha calculated to be .6 using the SPSS program
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Materials/Supplies:
Paper
Pens and Pencils
Folders
Computer- SPSS Program
Printer
Copy Machine
Projects Logistics
Personnel:
Dr. Sirjana Bajracharaya
Erica Weiss of the IC Hammond Health Center.
Ithaca College Students
Professor Tom Swenson
Professor Shewanee Howard
Professor Joanie Groome
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Results
A. What proportions of Ithaca College students were aware of Hookah?
Based on our results, approximately 91.9% of all subjects interviewed had heard of Hookah.
Furthermore that 91.9% was also able to correctly define it.
B. What were the general perceptions of Ithaca College students regarding Hookah?
SD = Strongly Disagree D = Disagree NO= No Opinion A= Agree SA=Strongly Agree
Statements SD D NO A SA
3. It is convenient using hookah 9 14.7 55.5 16.6 4.3
4. Hookah is less harmful than cigarettes and chewing
tobacco
11.4 27 31.8 25.6 4.3
5. Hookah is much more fun than other kinds of
tobacco
4.3 7.1 47.9 29.9 10.9
6. Now a days, hookah use is in fashion 2.8 10 43.1 37 7.1
7. Hookah use is more prevalent than most people
think
.5 6.6 37.9 51.2 3.8
8. Using Hookah makes one susceptible for infection
or disease
3.8 13.3 45.5 33.6 3.8
9. It is easier to use a Hookah than other tobacco
devices
8.5 29.4 50.2 11.4 .5
10. Hookah is best used in a party setting 2.4 13.3 49.3 26.1 9
11. Hookah is easy to find on campus .9 8.5 27.5 48.8 14.2
12. Most students start smoking hookah because it‟s a
safer alternative to cigarettes
5.7 18 52.1 20.4 3.8
13. Most students start smoking hookah out of
curiosity
.9 5.2 37 52.1 4.7
14. Most students start using hookah because of
pressure from friends
5.2 21.3 45 25.1 3.3
15. Most students who use Hookah do for religious
purposes
19.9 32.7 40.8 4.7 1.9
16. Hookah contains less tobacco than cigarettes or
chewing tobacco
10.4 14.7 57.8 15.6 1.4
17. There is little risk in getting sick from hookah use 9.5 39.8 39.8 9.5 1.4
18. Hookah is most prevalent in college populations 2.8 9.5 39.8 41.2 6.6
19. It is cheaper to smoke Hookah than other drugs 1.9 11.
8
59.7 23.7 2.8
20. College students who smoke hookah, only do so on
the weekends
15.6 41.7 36 62 .5
21. College students who smoke hookah, do so more 3.3 18.5 64.5 10 3.8
than 4 times week
22. Most people wipe down the hookah mouth piece
before passing it
21
24.6 36 34.1 4.7 .5

Based on the results of the perception questions, our group was able to uncover that although a
majority of the believed that using hookah did make them more susceptible to infection, there
was still about 18% who disagreed and approximately 11% of the subjects interviewed agreed or
strongly agreed that there was little risk of getting sick from using Hookah. There is a large
perception that people do not wipe down the mouth piece after use. In fact about sixty percent
believed disagreed or strongly disagreed that most people would wipe the mouth piece off.
However in order to accurately find out if that was true, we would have had to ask those who use
if they do wipe down the mouth piece because the perception would be exaggerated. There was
also a large belief among students that Hookah is safer than smoking cigarettes, and chewing
tobacco. Research has found that this is a false statement and Hookah in fact does contain more
nicotine and tar than cigarettes. Approximately twenty-four percent agreed or strongly agreed
that smoking Hookah was healthier.
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C. What proportions of Ithaca College students have been or are current users of
Hookah?
Of the 212 students surveyed, 51.5 percent have smoked Hookah, a majority starting to use
between the ages of 17-20; a range that is most associated with college years. For 83.5% of the
current users, it was friends who first introduced them to the trend and it was most commonly
curiosity that led to their engagement (Table 4.) For 94.4% of the subjects interviewed, they use
only once or less per week and approximately 1 % use every day (Table 3.)
Hookah Use
Have you ever smoked hookah? (%)
yes 51.1
no 48.9
What Age Did You First Start? (%)
10--13 4.3
14-16 24.5
17-20 69.1
20+ 2.1
Who First Introduced Hookah? (%)
family 9.9
friends 83.5
siblings 5.5
co-worker 1.1
How Often Do You Use Per Week? (%)
1--2 3.4
3--4 1.1
everyday 1.1
once or less 94.4
(Table 3)
90
80
70
60
50
40
30
20
10
0
23
Why Students Started
Smoking Hookah
Pressure
From
Friends
(Table 4)
Curiosity Family
Tradition
Other
(% Answered
Yes)

D. What was the expense of hookah use for Ithaca College Students?
The cost of a Hookah can range anywhere from $50 to $200, depending on the design and
number of pipes attached. It was our goal to see how being Hooked on Hookah was effecting the
wallets of students at Ithaca College. Based on the results, it was concluded that many of the
subjects do not own their own Hookah. In fact, 87.2% of the subjects interviewed use one of
their friend‟s hookah rather than buying their own. Of the other 12.9% who actually purchased a
hookah, the majority spent anywhere from seventy five to one hundred dollars. There is more
than just the expense of a hookah. Unlike cigarettes the tobacco/nicotine is not included and
needs to be purchased separately. The majority (98.7%) of students who have engaged or are
engaging in hookah use spend an average of ten dollars or less on tobacco each month. Mush of
the tobacco products are purchased down in the Ithaca Commons (35.2%) Others get is from
friends (14.1%) a shop at home (8.5%) or another source (39.4%)
Expenses of Hookah
How Much Spent on a Hookah? (%)
$75-$100 10.3
$150-$200 2.6
use a friends 87.2
How Much Spent on Tobacco per Month? (%)
less than $10 98.7
$10--$20 1.3
Where Do You Purchase Tobacco Products? (%)
the commons 35.2
a shop at home 8.5
from a friend 14.1
from a dealer 2.8
other 39.4
(Table 5)
24

E. What health risks do Ithaca College students associate with using Hookah
In order to gather data regarding this research question, an opened ended question was asked at
the end of the written survey. It asked what the subject believed was the greatest risk associated
with smoking Hookah. Through analyzing these answers it was found that the greatest risk
associated with hookah use was the spread of germs and disease. Twenty-five of the people put
this as an answer. Lung cancer/lung issues followed with twenty-one responses. Other responses
included addiction, education regarding Hookah, and tobacco. Seven individuals did not know
what the greatest risk was and three stated that there weren‟t any health risks. All the individual
responses given by the subjects are listed verbatim in Appendix. Another question used to gain
an understanding of Hookah and its health dangers was to find out if the student knew which
tobacco product contained more nicotine. The subjects were asked to rank the tobacco/nicotine
content of Hookah, Marijuana, Chewing Tobacco and Cigarettes from highest to lowest using a
scale of 1-5 (1 being the highest and 5 being the lowest.) Only 5.4% of subjects tested stated that
Hookah had the highest tobacco/nicotine content. Cigarettes were believed to be the highest by
48.4% of those surveyed and chewing tobacco the second highest (42.1 %.)
Perceived Percentage Perceived
Highest nicotine content Cigarettes 48.4
2 nd highest nicotine content Chewing Tobacco 40.4
3 rd highest nicotine content Hookah 58.2
Lowest nicotine content Marijuana 68.7
In actuality, a study done by the World Health Organization found that smoking Hookah
lead to the inhalation of more tar and nicotine (WHO, 2009.) The study showed that an average
Hookah smoking session, depending on the length could equal the amount of tar, nicotine and
carcinogens that enter the body when an individual smokes 40-400 cigarettes (WHO, 2009.)
25

Discussion
With hookah use on the rise among college aged students, there is a need to provide
information on the awareness of using it, the dangers and also information on quitting. With
conjunction of the Heath Center at Ithaca College, our needs assessment consisted of questions
asking about awareness, perceptions, behaviors, and knowledge of Ithaca College students. One
weakness of our survey was that the majority of students we collected data from were from
various Health majors. This most likely affected some results due to some previous awareness
and health concerns that arise from hookah use.
Our first question of our survey dealt with how well Ithaca College students were aware
of hookah use. About 92% of the students surveyed reported that they have heard of hookah at
some point of their lives. Also about 90% of those students that know what hookah is were able
to define what hookah is. We believe that the high percentage has to do with being some type of
health major and having at least some type of idea of what hookah is.
Our next set of questions we tried to get an idea of Ithaca College students‟ perceptions
of hookah. Our questions were on a Likert Scale of Strong Disagree (SD), Disagree (D), No
Opinion (NO), Agree (A), and Strongly Agree (SA). For many of the questions asking about
perception had No Opinion as their answer. This could be for various reasons. One being that
most of the students surveyed were freshman and sophomore age, meaning that some probably
didn‟t take this survey seriously and didn‟t answer truthfully. Some could have just gone right
down the middle answering the NO part of as their answer. The one questions that was
concerning to us was when we asked if most people though that others wiped down the mouth
piece before passing it on. About ¼ of students that were surveyed answered Strongly Disagree.
26

It is our belief that those students that said they SD with that question are involved in smoking
sessions that do not practice safe techniques.
One of our most concerning areas we wanted to get more information about from this
survey we conducted was the usage of hookah among Ithaca College students. Our surveyed
was analyzed and of our 212 students taking it, half of those Ithaca College students have
smoked Hookah at least once. When we asked the question of who introduced them to hookah,
the most repetitive response was that friends have introduced them and they used a friend‟s
device for smoking. The positive aspect was that just over 90% of students who have used
hookah barely smoke it once or less per week and also a slim number that are users everyday of
hookah. This is making us think these numbers are due also do being mostly health majors and
have had the education about hookah or tobacco use in general.
Our second most concerning topic dealing with hookah use is how much Ithaca College
students are spending on it. Just about 90% of students we surveyed noted that they use a
friend‟s and wouldn‟t buy one of their own. We have thoughts that students aren‟t spending a lot
of money on hookah. The cost of the tobacco is really what is being purchased and we noted that
it is easily accessible. The most common place that the students are getting the tobacco products
are from another source than the Commons, a friends and also someplace from home. Now we
are just concerned from where they are getting it since they answered none of our specific
sources.
Our last sets of questions on our survey were how much knowledge they have about
hookah. We focused mainly on the health risks on the use of hookah. As we asked an open
ended question on the biggest risk of smoking hookah, a quarter of the 212 students we surveyed
27

eported germs and disease being the greatest risk factor with using hookah. We then asked to
rank how much tobacco/nicotine was in four different products- cigarettes, chewing tobacco,
Marijuana and then Hookah. All were very close within each other. This statistic makes us
believe that students don‟t really know how much tobacco/nicotine is in these different products
that are being used today. More information needs to be educated to students about the risks
with using hookah.
After we analyzed the percentages of each question we came up with some conclusions.
Based on our survey we found out that we need to have a more diverse population than just
health majors to see if the different majors would have an impact on the knowledge and
perception questions of the survey. Most of this was due to time constraints that didn‟t allow us
to collect data from different majors. Also we there is a need to figure out how they are getting
the tobacco for the hookah. Now we have a better idea of what information is needed at the
Health Center about further continuing education of hookah use.
28

Recommendations
For the Ithaca Hammond Health Center
1. Provide Obtainable Information
About half of the students surveyed at Ithaca College say they have smoked Hookah at least
once. Ninety-four percent of those individuals stated that they use it once or less times a week.
For the high prevalence of use on campus, approximately half the student body, more obtainable
information needs to be provided. Some student do not have the opportunity to go to the Health
Center during their day to get information or the thought of walking into the Health Center to
obtain this information may scare them on what other will think. Although it is important to have
information in the Health Center itself, perhaps making pamphlets available throughout campus
as well as online through the website would also be effective.
2. Target the Right Population
Although Hookah affects everyone it is important to target the campaign toward the right
population in order to have the greatest effect. Approximately sixty-nine percent (69.1%) of
students surveyed stated that they started using Hookah between the ages of 17 and 20.
Individuals of that age are in high school or just entering college. More information should be
directed towards first year students. There could be a seminar on drugs and alcohol use where
hookah information could be given. Through our research, we have learned that the
consequences of Hookah can be just as sever if not more severe than that of tobacco and alcohol
which is why it should be include in seminars about tobacco use and alcohol. This could
decrease the use of hookah on Ithaca College campus. Also, Hookah use and information could
29

also become part of the program that all college students are required to take before moving on
campus, Alcohol EDU. This is an extensive online course that covers information about alcohol
and its effects as well as an individual‟s use. Hookah and other drug usage could be added as
another section to this course. In doing so, this could increase awareness and decrease the levels
of curiosity which was the number one reason why students at Ithaca College started using
Hookah.
3. Promote the Ithaca Hammond Health Center
There are many indications throughout the perceptions section results of our survey that high
light some issues that students are confused about. One of those confusions deals with the
difference between smoking hookah and smoking cigarettes. In contingency with this student
also are unaware with the amount of nicotine that is in hookah and cigarettes. This are very large
concerns and not only do the students do not know about the differences, they are unaware of
where on campus they could acquire information. When given options about where to go to get
information about Hookah the Ithaca College Health Center was not one of the top choices
students chose. The Health Center should make it more known to students about the different
topics that they can get information on in the facility. If college students are unaware of hookah
information being available at the Health Center, there could be other aspects that the Hammond
Health Center has to offer that the students are unaware of. Results throughout the perceptions
section can be used as a valuable source that can help the Health Center develop an informational
campaign to educate college students on the affects of hookah use.
30

Recommendations
For Future Student Participating in the Service Learning Project
1. Start and organize work as soon as possible
Even though it may seem like you have a lot of time there are many steps to the process and can
take time to complete especially if doing a research survey. Breaking up the written parts of the
paper between group members is helpful in organizations and working diligently. Have a set goal
of when you want each part completed, and have frequent meetings a few minutes before or after
class to make sure everyone is keeping up with their work. It may be best to delegate one person
to send all the completed work to so it can be compiled over time. This will make completing the
project much easier when the time comes.
2. Use Survey Monkey
Computing the data and gathering results takes the longest time of any part of the research
question project. The work for this section is extremely time consuming if you use SPSS
software. Using this process you have to distribute the surveys by hand to classrooms, which can
be hard to find professors who will allow you to interrupt their class time, waiting for the results,
inputting the results by hand on the computer, and then organizing and evaluating the data.
However, survey monkey will allow you to make the survey online, send it out, and compile the
results as they get completed all in one simple step. This will give you more time to see your
results and complete the conclusions of the project and paper without being stressed out about
time.
31

3. Create and short but efficient survey
Many students failed to complete our survey or skipped multiple sections because of the length;
it was time consuming. Make sure that your survey covers what you are trying to reveal in a
clear and concise manner. Another aspect of creating a survey is formulating the questions as to
gain the information you want but not giving the subject too much information as to guide them
to the answers you want. There were some question on our survey that made it very obvious as to
what answers we wanted and exactly what we were studying. This could have caused a possible
discrepancy in our results. The survey should include questions that answer the research
questions that were formulated in the beginning of the project but without coaxing a specific
response from the subject. It may seem difficult, but try to avoid redundancy of questions that
use a scale, such as disagree, agree, strongly disagree, etc. These types of questions were the
most frequently skipped on our surveys.
4. Stay organized and focused
Even though this project has a deadline months in advance, a group should start early and work
on small sections each week. Do not let weeks go by where no work is done on the project
because it will catch up to the group in the end especially if inputting data by hand into the
computer is a task of the project. A failure to stay on top of the work and assignments could
cause a lot of stress upon the group and an inability to complete the work to the group‟s full
potential. Utilize all class time you are given and keep your teammates on the same page and
working hard.
32

References
American Lung Association. (2007, February). An emerging deadly trend: water pipe tobacco use in
tobacco policy trend alert. Retrieved from
http://teachers.sduhsd.net/READ/PDF%20Files/Trendalert_waterpipe/pdf
Bingler, A. (2009, March 24). Survey shows hookah use increasing at local colleges. Retrieved from
http://www.thebrownandwhite.com
Center of Disease Control (2009, April.) Tobacco use among students aged 13-15 years. (2009, April
3). MMWK Weekly, 58.
Center of Disease Control (2006) Use of cigarettes and other tobacco products among students aged
13-15 worldwide1999-2005. MMWK Weekly, 55.
Chaovach, K. (2009, February). Hookah smoking and environmental tobacco smoke (ETS): a critical
review of the relevant literature of the public health. International Journal Environ Des
Public Health, 6, 798-843.
Elliott, A. (n.d). Bars and Restaurants Thrive Amid Smoking Ban, Study Says. Retrieved from
http://archive .naccho.org/documents/Bars-Restuarants-Smoke-Ban.pdf
Facebook (2009.) http://facebook.com/pages/Hookah/71842507877
Frequently asked questions. (n.d.). Retrieved October6, 2009, from http://www.hookah
bars.com
Munzer (2005.) Hookah palooza. The Ithacan.
http://www.ithaca.edu/articles/0504/07/accent/0hookah_pa.htm
Primack, B., Aronson, J., & Agarwal, A. (2006, August). An old custom, a new
threat to tobacco control. American Journal of Public Health, 96(8).
Prokhorn, A., Winickott, J., Ahluwalia, J., & Ossi-Klien, D. (2006, September). Pediatrics. Official
Journal of the American Academy of Pediatrics, 118, 890-903.
Tobacco Free U. (n.d.). Reducing hookah use: a public health challenge for the 21st century.
Retrieved from http://tobaccofreeu.org
Tobacco Free U. (2007, May). Top facts: Hookahs. Retrieved from http://www.tobaccofree.org
University of Pittsburgh School of Medline. (2008, September 4). Hookah smoking more popular
than expected among college students. Retrieved October 6, 2009, from
http://www.upmc.com/mediarelations/newsreleases/2008/pages/primack-waterpipe.aspx
University of Pittsburgh School of Medline. (2009, May 12). 15 Percent of Arizona High School Seniors
Have Smoked Tobacco From a Hookah Pit Study Finds. Retrieved October 6, 2009, from
http://www.upmc.com/mediarelations/newsreleases/2009/pages/primack-arizona hookah.aspx
33

Appendix A
34

ALL-COLLEGE REVIEW BOARD
FOR
HUMAN SUBJECTS RESEARCH
COVER PAGE
Investigators: Alexandra Ferretti, Lindsey Jones, James Onisk, and Gina
Rosato, Srijana Bajracharya (faculty advisor)___________
Department: Health Promotion and Physical Education
Telephone: __274-3411
Project Title:
A Needs Assessment of Ithaca College Students Awareness, Knowledge, Behaviors and
Attitudes Toward Smoking Hookah
Abstract:
According to the American Lunch Association news report, hookah trends are emerging across
the United States especially among the 18-24 year old crowd. It is becoming the “new tobacco
trend of the 21 st century (American Lung Association, 2007). However, the problem is not just
the increasing trend but also the lack of knowledge regarding the dangers of Hookah use. The
fact of the matter is that a session of smoking Hookah usually lasts approximately forty-five
minutes versus the usual five to ten minutes it takes for an individual to smoke a cigarette. In that
forty-five minutes a person inhales the equivalency of a whole pack of cigarettes (The Bacchus
Network, 2007). The facts are that in Hookah smoke there are higher levels of arsenic, lead,
nickel, thirty-six times more tar and fifteen times more carbon monoxide than cigarette smoke
(The Bacchus Network, 2007). The population that is more affected by this trend is the college
population. Much of this population is misinformed about the health risks that are associated
with the use (Bingler, 2009). College students state that smoking hookah is a nice way to relax
after a stressful day, and because people think that it is less dangerous than smoking cigarettes, it
35

is more appealing (Bingler,2009). It is for this reason that the Hammond Health Center wanted to
conduct a needs assessment for the prevalence of Hookah use at Ithaca College as well as the
knowledge, awareness, attitudes, and behavior of the students. The results showed that many
Ithaca College students lack the knowledge regarding the nicotine levels in Hookah and believe
it would be a safer choice than cigarettes. Based on those results, the Hammond Health Center
will construct informational pamphlets and seminars to create a campaign to educate students on
the dangers of Hookah use.
Proposed Date of Implementation: October last week
Alexandra Ferretti, Lindsey Jones,James Onisk, and Gina Rosato, Srijana Bajracharya (faculty
advisor)_Print or Type Name of Principal Investigator and Faculty Advisor
________________________________________________________________
Signature (use blue ink) Principal Investigator and Faculty Advisor
36

Protocol for Human Subjects Protection
Paper and Pencil Survey of Adult Subjects
Development & Evaluation of Health Promotion Programs
A Needs Assessment of Ithaca College Students Awareness, Knowledge, Behaviors and
Attitudes Toward Smoking Hookah
1. Topic/Research Question:
Allie Ferretti
Lindsey Jones
James Onisk
Gina Rosato
a. What proportions of Ithaca College students were aware of Hookah?
b. What were the general perceptions of Ithaca College students regarding Hookah?
c. What proportion of Ithaca College students are current users of Hookah?
d. What was the expense of hookah use for Ithaca College Students?
e. What health risks do Ithaca College students associate with using Hookah?
2. General Information:
Tobacco takes someone‟s life every six seconds. It also kills a third to a half of the people
who use it about 15 years prematurely. Tobacco use causes 1 in 10 deaths among adults
worldwide and more than 5 million people a year. If nothing is done about this problem by the
year 2030 tobaccos annual death toll will rise to more than eight million. Many have come to
believe that using other kinds of tobacco or smoking it in different ways will be less hazardless,
37

which is not the case. A popular form of smoking tobacco by college students is through a water
pipe or “hookah.” (The global tobacco crisis)
The purpose of our service learning project is to find out the knowledge, attitudes,
perceptions and behaviors of Ithaca College students regarding Hookah. This information will
then be used by the Hammond Health Center in order to create a campaign to educate students
about Hookah and the dangers of it.
a) Funding: None
b) Location: The location o the study will be Ithaca College. The survey participants will
Ithaca College students.
c) Time period: All the projects will be finished within the fall semester, 2009.
d) Expected Outcomes: The findings foe this research will shed some light about IC
students‟ awareness knowledge level, their attitudes regarding various issues surrounding
Hookah use, and their behaviors on the use.
3. Ethical Issues:
a) Surveys- We are required to point out the voluntary participation, anonymity, age limit
for the study, and presentation of data only as group scores. All surveys will be collected
in a closed ballot box or envelope. No names or any kind of personal identification will
be recorded. No ethical issues are anticipated by surveying student about hookah.
4. Subjects:
All subjects who will be surveyed or interviewed will be 18 years or older from Itahca College.
5. Selection of Subjects:
Students will make a list of the classes that qualify education status. They will select 3-4 large
classes and contact the faculty members who are teaching these courses and ask for their
permission to survey students. Once they get a letter of support from these instructors, they then
are allowed to administer the survey in the class. Students will present the information in the tearoff
cover page about the purposes of the study, anonymity, and the fact that students do not have
to answer any questions that they do not feel comfortable answering.
6. Anonymity:
As a part of the learning process about handling ethical issues, anonymity and confidentiality are
discussed in the class. Students need to comply to the guidelines when they put together a cover
letter and survey collection methods. Surveys will be collected in a close ballot box or an
envelope. No names or any kind of personal identification will be asked to put on the survey.
38

Dear Students,
Knowledge, Attitudes, and Behavior Regarding Hookah Survey
As part of our Development and Evaluation of Health Programs class, we are conducting a
survey on students‟ Knowledge, Attitudes, and Behavior Regarding Hookah use. This survey is
anonymous and will only be used for the purposes of research. Answering these questions will
not affect your academic or social life here at Ithaca. The results will be analyzed and compiled
to find out Ithaca‟s Colleges view and on Hookah as well as use. The results will lead to possible
changes in the Hammond Health Center and information that they give out regarding health care.
Since this survey is anonymous, please do not put any identification on this survey such as your
name or your id number. This survey should only take approximately 10 minutes to complete.
By completing this survey, you have verified that:
You are 18 years of age or older
Participation is voluntary
You can stop taking this survey at any time
The survey is anonymous
This project has been approved by The All-College Board of Human Subject Research in
College. Please tear off this cover page and keep it for your records. If you have any concerns or
questions regarding this survey you can contact Dr. Srijana Bajracharya at:
sbajracharya@ithaca.edu. The counseling services will also be available for anyone who needs it.
Thank you for your help,
Lindsey Jones
James Onisk
Gina Rosato
Allie Ferretti
39

23. Have you ever heard of Hookah(circle one): Yes No
24. What do you think Hookah is…?
a. A type of religion where they strongly belief in magic, witchery and wizards
b. An American artist famous for his works with charcoal and water paints
c. A single or multi-stemmed water pipe used for smoking tobacco products
d. A type of drug that is most effective when crushed and snorted through the nasal air
passages
e. I don‟t know
**If answered NO to question 1 then skip to question 39**
SD = Strongly Disagree D = Disagree NO= No Opinion A= Agree SA=Strongly Agree
Statements
25. It is convenient using hookah
26. Hookah is less harmful than cigarettes and chewing tobacco
27. Hookah is much more fun than other kinds of tobacco
28. Now a days, hookah use is in fashion
29. Hookah use is more prevalent than most people think
30. Using Hookah makes one susceptible for infection or disease
31. It is easier to use a Hookah than other tobacco devices
32. Hookah is best used in a party setting
33. Hookah is easy to find on campus
34. Most students start smoking hookah because it‟s a safer
alternative to cigarettes
35. Most students start smoking hookah out of curiosity
36. Most students start using hookah because of pressure from
friends
37. Most students who use Hookah do for religious purposes
38. Hookah contains less tobacco than cigarettes or chewing
tobacco
39. There is little risk in getting sick from hookah use
40. Hookah is most prevalent in college populations
41. It is cheaper to smoke Hookah than other drugs
SD D NO A SA
42. College students who smoke hookah, only do so on the
weekends
43. College students who smoke hookah, do so more than 4 times
week
44. Most people wipe down the hookah mouth piece before passing
it
45. Based on nicotine content, rank the following from 1-5 based on nicotine content (1 being the
highest and 5 being the lowest
___Hookah
___Marijuana
___Chewing Tobacco
___Cigarettes
40

46. Have you used/or currently using any of the following drugs (check all that apply)
___Alcohol
___Chewing tobacco
___Cigarettes
___Marijuana
___Cocaine
___None of the Above
47. Have you ever smoked Hookah? Yes No
**If you answered NO to the above question please skip to question 39**
48. At what age did you first engage with hookah use?
a. 10-13
b. 14-16
c. 17-20
d. 20+
49. Who first introduced you to Hookah
a. Family
b. Friends
c. Siblings
d. Co-worker
50. Why did you start using? (circle all that apply)
a. Pressure from friends
b. Curiosity
c. Family tradition/religion based
d. Other___________
51. How often do you use per week?
a. 1-2
b. 3-4
c. Everyday
d. Once or less
52. How much did you spend on a Hookah
a. $75-$100
b. $100-$150
c. $150-$200
d. Above $200
e. Nothing-I use a friends
41

53. How much do you spend on Hookah tobacco a month
a. < $10
b. $10-$20
c. $20-$40
54. Where do you purchase tobacco products?
a. The Commons
b. Shop at Home
c. Friends
d. A dealer
e. Other ______________
55. Are you addicted to tobacco? Yes No
56. Have you ever tried quitting? Yes No N/A
57. Did you succeed? Yes No N/A
58. Who would you go to in order to obtain information about tobacco use and quitting? (check all
that apply)
___Family
___Friends
___Online Sources
___Ithaca Health Care Center
___Doctor/Practitioners
___Other
59. In your opinion what is the greatest risk of Hookah use?
60. What is your age______
61. Gender (circle one): Male Female Transgendered
62. Year (circle one): Freshmen Sophomore Junior Senior Grad
63. Major:_________________
64. Ethnicity(circle one): White/Non Hispanic African American/Black Latino/Hispanic
Comments:
Asian/Pacific Islander American Indian Other:_______
THANK YOU FOR YOUR PARTICPATION
42

Appendix B
43

What is the greatest risk of Hookah? (as told by the students)
1 --
2 --
3 Tobacco related disease
4 --
5 Lung condition
6 Getting sick from sharing tubes
7 --
8 Cancer
9 --
10 --
11 No idea
12 --
13 ?
14 IDK
15 Lung cancer
16 --
17 --
18 --
19 --
20 --
21 --
22 --
23 --
24 --
25 --
26 --
27 --
28 --
29 --
30 --
31 --
32 Catching a cold from sharing mouth piece
33 Your mother
34 --
35 --
36 --
37 Bad for your lungs and bacteria from passing
38 --
39 Same as tobacco use
40 Spread of infection
41 Risks associated with tobacco use, lung problems
42 Thinking it’s safer than cigarettes
43 --
44 --
45 Spread of germs, normal dancers of tobacco
46 The smoke seems thicker and heavier making me think there are more carcinogens
and tar
44

47 Germs
48 Addiction
49 Tobacco
50 --
51 Don’t know
52 Spreading germs
53 Same as other smoking and tobacco products
54 Lung disease
55 Nada
56 Loss or originality
57 Nothing, it’s not a drug
58 --
59 Spreading illness, light headedness, nausea
60 Germ spread
61 ---
62 ----
63 The smoke and your lungs
64 --
65 --
66 Lack of understand and education
67 --
68 --
69 --
70 Sick if friends are sick, tobacco/nicotine
71 --
72 --
73 --
74 --
75 --
76 --
77 --
78 --
79 --
80 --
81 --
82 --
83 --
84 --
85 --
86 --
87 Lungs
88 Dropping to coal
89 --
90 It is tobacco and many people touch the mouthpiece so it carries disease
91 --
92 --
93 Lung problems
94 --
95 People don’t wipe off the mouth pieces! It’s so nasty, that’s what made me quit!
45

96 Tobacco use, disease spread
97 Lung cancer
98 Getting sick/infection
99 --
100 --
101 --
102 --
103 --
104 --
105 --
106 --
107 --
108 --
109 Nicotine addiction
110 Germs from other users
111 None
112 --
113 --
114 --
115 --
116 --
117 --
118 Lung issues
119 Germ spreading, hurt lungs
120 Spreading germs
121 Tobacco
122 --
123 --
124 --
125 --
126 --
127 --
128 --
129 --
130 --
131 --
132 --
133 --
134 --
135 --
136 --
137 --
138 --
139 Infection
140 --
141 --
142 Getting sick
143 Lung cancer/infectious disease
144 --
46

145 --
146 --
147 Cancer
148 --
149 --
150 --
151 --
152 --
153 Addiction-leading to health problems
154 Sick/addiction
155 Cancer
156 --
157 Getting caught smoking inside
158 I only tried it once and didn’t like it. It hurt my lungs as it would for most others who
use it. Because there is tobacco in it, it can cause serious lung damage.
159 --
160 Having such a chill time that you realize going out into the outside world would be
devastating to your bro time with your bro’s
161 --
162 --
163 --
164 Same risks as cigarettes and other tobacco products
165 Getting sick from other people
166 Spread disease from the hose
167 Smoke inhalation=bad for lungs
168 No idea
169 --
170 Lung cancer
171 --
172 --
173 Not getting laid
174 --
175 --
176 --
177 --
178 --
179 --
180 Sharing a mouthpiece and getting sick that way
181 --
182 --
183 --
184 --
185 --
186 --
187 --
188 Lung damage
189 --
190 --
191 No idea
47

192 --
193 It’s a dumb college trend that people think is raunchy
194 --
195 --
196 --
197 --
198 N/A
199 --
200 --
201 --
202 Lung cancer. Most people think it’s better than cigarettes but it’s actually worse.
203 --
204 --
205 Germs
206 --
207 --
208 --
209 --
210 --
211 Swine
212 --
48

Appendix C
49

Common Myths:
1. Because the smoke of a Hookah is
filtered through water, it does not
have any harmful chemicals
False- the filtering through water does
not filter out the carcinogens that can
lead to cancer and other health
complications.
2. Smoking a hookah is healthier
than smoking a cigarette
False- The only difference between a
hookah and a cigarette is how the smoke
is generated. Smoke in a Hookah is
created in a bowl using charcoal while
cigarette smoke is created by burning
tobacco.
3. Smoking Hookah is not as
addictive as smoking cigarettes
False-Shisha (Hookah tobacco) is just
like tobacco in cigarettes and contains
nicotine. Nicotine is addictive.
NEED MORE INFORMATION OR HELP
QUITTING?
Contact the Hammond Health Center
Call the Quit line: 1-866-NY-QUITS
**info provided by Tobacco Free U and The Bacchus Network**
50
The Facts About How Hookah Effects
Your Health
Smoking Hookah can lead to
o Lung cancer
o Oral cancer
o Bladder cancer
o Esophagus cancer
o Stomach cancer
o Respiratory Problems
o Nicotine Dependence
o Infections including
tuberculosis, oral herpes,
and hepatitis